PurposeThe objectives of this study were to assess the potential value of Ki-67 in predicting response to neoadjuvant chemotherapy in breast cancer patients and to suggest a reasonable cutoff value for classifying Ki-67 expression.MethodsThis study included 74 breast cancer patients who underwent surgery after anthracycline-based neoadjuvant chemotherapy between 2007 and 2012. We analyzed the clinical and immunohistochemical characteristics using core biopsy specimens obtained before neoadjuvant chemotherapy to determine their correlations with the response to chemotherapy.ResultsA clinical complete response was observed in 6 patients (8.1%); a clinical partial response, in 44 patients (59.5%); and clinical stable disease, in 24 patients (32.4%). A pathologic complete response (pCR) was observed in 10 patients (13.5%). In univariate analysis, estrogen receptor (ER) negativity (p=0.031), human epidermal growth factor receptor 2 (HER2) positivity (p=0.040), and high Ki-67 expression (p=0.036) were predictive factors for a pCR. In multivariate analysis, Ki-67 was the only independent predictor of a pCR (p=0.049). The analysis of Ki-67 values revealed that 25% was a reasonable cutoff value for predicting the response to chemotherapy. In subgroup analysis, a higher Ki-67 value (≥25%) was a significant predictive factor for the response to neoadjuvant chemotherapy, especially in ER-negative and HER2-positive breast cancer patients.ConclusionKi-67 expression in breast cancer tissue may be an effective factor for predicting the response to neoadjuvant chemotherapy. We suggest that a 25% level of Ki-67 expression is a reasonable cutoff value for predicting a response to chemotherapy. Moreover, Ki-67 is a useful predictive factor for pCR, especially in patients with ER-negative and HER2-positive breast cancer.
This study showed that the pattern of increased extent of microcalcification on screening mammography was a significant predictor for breast cancer. We suggest that mammography-guided needle localization and surgical excision should be considered when increased extent of microcalcification is observed on screening mammography and closed follow-up without pathologic confirmation can be permitted if absence of extension of microcalcification was confirmed in women younger than 50 years.
Background/Purpose Adjuvant endocrine therapy in patients with hormone receptor positive breast cancer reduces recurrence and mortality, but many patients are non-adherent to anti-hormonal medication. In order to increase the adherence, it is important to know about factors associated with adherence. So we investigated factors associated with adherence to anti-hormonal medication using variable questionnaires. Methods We carried out a cross-sectional survey of a sample of women who underwent surgery due to breast cancer in the Seoul National University Hospital Breast Care Center from 2007 to 2011 and treated with anti-hormonal medication. Questionnaires were sent to 1,000 patients. The questionnaire booklet included the Medication Adherence Report Scale-5(MARS-5), Women’s Health Questionnaire(WHQ), Beliefs about Medicine Questionnaire(BMQ), Satisfaction with Information about Medicines Scale(SIMS). And to identify patient’s clinical characteristics, we reviewed electronic medical records, retrospectively. Result The response rate of questionnaire was 40.8%(408/1000). Of the answered patients, 263 patients were treated with tamoxifen and 145 patients were treated with aromatase inhibitors(AIs). 197 of 408 answered patients(48.3%) were classified as non-adherence. The rate of non-adherence was 132/263(50.1%) and 65/145(44.8%) in patients treated with tamoxifen and AIs. Of the all answered patients, non-adherent patients had more depressed mood (p<0.001). Non-adherent patients scored lower on positive beliefs as measured on BMQ-necessity (OR = 0.65, 95% CI 0.51 to 0.82) and higher on negative beliefs as measured on BMQ-overuse (OR=1.81, 95% CI 1.29 to 2.54). Non-adherent patients also scored lower on satisfaction with information about action and usage of anti-hormonal treatment as measured on SIMS-action and usage (OR = 0.47, 95% CI 0.38 to 0.65). Of the patients treated with tamoxifen, non-adherent patients had more depressed mood (p=0.003), scored higher on BMQ-overuse (OR=1.97, 95% CI 1.22 to 3.20) and scored lower on SIMS-action and usage (OR = 0.33, 95% CI 0.22 to 0.50). Of the patients treated with AIs, non-adherent patients had more depressed mood (p=0.014), scored lower on BMQ-necessity (OR=0.52, 95% CI 0.36 to 0.75). Conclusion This study showed associations between depressive mood of breast cancer patients treated with anti-hormonal therapy and adherence. And beliefs and satisfaction with information about medication also associated with adherence. To improve adherence, we should evaluate and correct patient’s mood. And we should provide proper information about medications. Citation Format: Jongjin Kim, Wonshik Han, Hyeong-Gon Moon, Min Kyoon Kim, Eunshin Lee, Tae-Kyung Yoo, Han-Byoel Lee, Young Joon Kang, Yun-Gyoung Kim, Tae Ryung Kim, Dong Young Noh. Factors associated with adherence to adjuvant endocrine therapy in patients with hormone receptor positive breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-12-13.
Delayed metastasis only to contralateral regional lymph nodes of a unilateral breast cancer has been considered as a systemic metastasis or a regional metastasis from contralateral primary occult breast cancer. This staging uncertainty has complicated for clinicians to choose treatment regimens for it. We report a case of a 52-year-old woman with metastasis only to contralateral regional lymph nodes 20 months after prior treatment of a unilateral breast cancer. She was treated with lymph node dissection, radiation therapy, chemotherapy, and hormonal therapy. Now 13 months after second surgery, the patient is alive without any evidence of breast cancer recurrence or metastasis. We suggest that solitary contralateral regional metastasis, especially post-breast-conserving surgery followed by radiation therapy, should be considered not only as hematogenous spread but also lymphatic spread. Although controversial, lymph node dissection for the delayed metastasis of breast cancer only to the contralateral regional lymph nodes can be of curative intent.
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